“Game-Changing Pick” Under Consideration to Head New Foreign Assistance Effort

Dr. Paul Farmer, a founder of Partners in Health, recipient of the MacArthur “genius” award and a long-time provider of and advocate for basic health care for the poor is under consideration by the Obama Administration to head a newly overhauled foreign assistance program, according to sources close to Farmer. He will be meeting with Secretary of State Hillary Clinton this week to discuss the post.

Farmer, is a world renowned medical doctor, anthropologist and human rights activist, who began his career in the 1980s by bringing basic health care to the poor in Haiti, a country in which he has continued to work for over 20 years. His focus on human rights as an organizing principal for access to health services sets him apart from mainstream development policy and practice. This is in no small part because he often challenges the basic premise of “trickle down” theories inherent in the delivery of much of traditional development assistance, which often uses the rhetoric of human rights without adhering to the principles of a human rights approach to development. “If access to health care is considered a human right,” asks Farmer, “who is considered human enough to have that right?”

“Paul has a vision that is grounded in what he has learned in Haiti and elsewhere throughout a 20-year development career,” said a source close to Farmer speaking on condition of anonymity.

“He has a vision of how to benefit the poor, starting from a principle of truly community-based and sustainable efforts that involve the population and work in collaboration with the local government to achieve real outcomes.”

“If this vision could be spread to even part of US foreign assistance, “ continued the source, “it would save a lot more lives, and dramatically improve health and improve economic conditions.”

Sources close to Farmer also confirm that he is in discussion to lead a wholly revised U.S. international assistance strategy, with portfolio over all non-military U.S. foreign assistance, including but not limited to the programs funded by USAID, the President’s Emergency Plan for AIDS Relief (PEPFAR), the Millennium Challenge Account, humanitarian assistance, emergency assistance and potentially food aid. This would be a wholly new position with far broader purview than the current USAID Administrator’s portfolio. Such a reorganization would also be in keeping with calls by many advocates who have long criticized the lack of integration within and across health and development programs funded through USAID and other agencies, including the State Department.

Kaiser Network and the Boston Globe reported earlier this week that Farmer had not yet decided whether he would take a government position, but sources close to Farmer contacted for this article said that this past weekend he expressed eagerness to take the post if it entailed a reorganized U.S. foreign assistance strategy, and if he has widespread grassroots support from the global health community.

And, in fact, many health advocates are ecstatic at the prospect of Farmer taking on this role. “This is a precious opportunity for all those who care about the health and well-being of people around the world,” said Gregg Gonsalves, an international AIDS advocate and co-founder of the International Treatment Preparedness Coalition (a coalition including thousands of advocates and researchers in over 135 countries).

“What better chance to change things for the better than to have Paul at the helm? He is a pioneer in health and human rights.”

People who have worked with Farmer assert that he is also an advocate for sexual and reproductive health and rights. According to another source who has worked directly with Farmer but asked not to be named:

"The first programs [Paul] started in Haiti focused on women’s health. He is a strong believer in women’s access to primary sexual and reproductive health services. And while Partners in Health always worked within the law of a given country, and did not provide safe abortions where these were legal, Paul saw and treated botched abortions all the time."

Gonsalves and others have high hopes for Farmer’s ability to work across silo-ed programs to ensure that health services are themselves integrated and meet the needs of the poor, while also ensuring collaboration and integration across other portfolios to expand access to safe water, increase food security, and meet other fundamental human needs. While U.S. assistance has long-standing programs in these areas, they remain largely uncoordinated and often unconnected, making it difficult to achieve sustainable gains in any given area.
Gonsalves and other AIDS advocates contacted for this story underscored that having Farmer overseeing development programs would go a long way toward the recent disappointment caused by less-than-hoped-for-levels of funding for global health programs in the President’s 2010 budget.

“Putting Paul in charge is change of the kind we all hoped for,” said Gonsalves.

“He represents a new kind of vision for global health, because he is not an insider, not a bureaucrat, not just interested in making incremental changes. He wants to reform the way we fund and measure overseas development going forward. He also understands that AIDS has been a catalyst for change in global health and he realizes that there are positive ways to build on this change.”

“If Obama is real about wanting to change the way overseas foreign development is conducted," said Gonsalves, "he will have a willing partner in Farmer."

"Nothing in DC is ever done until it is done," he continued. "But all I can say is that this would be a game-changing appointment, an unprecedented one in my lifetime, and yes, change we can truly believe in this time."

State Department representatives and others in the community could not be reached in time for this posting, but RH Reality Check will continue to update this story as it develops and provide reaction from other sources.

This would be extraordinary!!!!!!!!!!!!!!!! Paul has directly influenced all that I have done in my career…and I think the possibility this brings is astounding.

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Holy cow! I first learned about Farmer in a university anthropology class, and since then have admired him for all the courageous work he’s done. Putting him in charge of U.S. foreign assistance is like having Dizzy Gillespie teach a music class! Kudos to Obama for such a top-flight pick.

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Yes! Yes! Yes!!!!!

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I don’t see Farmer being successful in USG foreign assistance. The reasons that he is successful heading his NGO– his faith, his uncompromising belief in health as a right, his willingness to cut corners to get things done, etc. would make it difficult for him to manage programs with Congressional oversight that must put foreign policy objectives over abstract notions of rights, etc. If he is offered and does take the post, I would not expect him to last more than a year at best.

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Paul Farmer and Partners in Health have done amazing work delivering health services to the poor and pointing out that failing to do so is a moral choice we may well make, but one that we will be held accountable for.

That said, I am not sure he supports abortion rights. Saving women who have survived unsafe abortions is not the same as advancing an agenda that makes unsafe abortion a thing of the past. Anyone have any insight?

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The divorce cases, the destroyed destinies of children, abortions, venereal diseases, infection with AIDS etc. Here the small part of that to what is reduced immorality in sexual relations.

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I understand the skepticism, although I think it says a lot more about the pessimism about foreign assistance than it does about Farmer. Kind of depressing that we don’t think we can attract the best and the brightest because our aid bureacracy is too messed up. I’m hopeful that the things that have made him successful at his NGO are exactly the things that could make him a transformational leader within government.

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Hi
I was curious that Gregg Gonsalves suggests that Farmer would support SRHR? His treatment programming in Haiti – had quite a narrow lens on treatment – so for example, if he saw lots of abortions – why did he make this not absolutely central to treatment – like partnering with groups providing post abortion caring and training.
With a global feminized epidemic and one in which unsafe sex contributes to HIV infection and unwanted pregnancy – its important to consider that we need an active supporter – not a passive one – With 84% of the worlds maternal mortality taking place in SADC essentially related to bleeding – HIV blood or not – we need a person who can support efforts to really integrate SRHR into programmes

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In an op-ed in the Post last year, Farmer was pretty clear that his program in Haiti is not narrowly focused on treatment:

First, our nonprofit organization, Partners in Health, has worked closely with the Haitian Ministry of Health to strengthen public health infrastructure. We have rebuilt, equipped, staffed and stocked hospitals and clinics; trained nurse-midwives and other personnel, including more than a thousand community health workers; linked villages and health centers to district hospitals by modern telecommunications and ambulance service; and established modern surgical services for obstetrical emergencies.

Second, we have broken the rule that high-quality health services are a privilege rationed by ability to pay, not a right. The case was made first for affordable medicines. Now it is being made for emergency Caesarean sections — an essential tool to reduce maternal mortality. Faced with evidence that maternal mortality was greater where fees were higher, the district health commissioner for central Haiti announced last August that all prenatal care and emergency obstetrical services would henceforth be available free to all patients. He was later echoed by Haitian President René Préval.

Third, we have linked prenatal and obstetric care to an all-out effort to improve access to primary health care. The presence of functional, accessible public clinics and hospitals restores faith in the health system, motivates people to seek care before they are critically ill and allows for preventive interventions such as prenatal care and family planning.

The opportunity for Paul Farmer to bring his understanding of health as a human right, and his knowledge of how foreign assistance can be delivered wisely,and to work together with the foreign policy makers would surely be so beneficial, however long it may last.

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Anyone who knows Paul Farmer’s work would know that the health, rights and well-being of women is central to what he does. Anyone who doesn’t know his work should read Women, AIDS and Poverty: Sex, Drugs and Structural Violence for a start.

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Paul Farmer is an amazing and fearless and daunting advocate…and has been one of the few leaders who puts social justice and human rights into daily practice through his work.

Paul was an early and strong voice on women in the HIV epidemic – and edited an outstanding book, Women, Poverty, and AIDS: Sex, Drugs, and Structural Violence. He has been an important voice on understanding the structural determinants driving the epidemic – and at the frontlines of taking comprehensive approaches to advancing health.

Paul’s work demonstrated that ART in resource poor settings is possible – and he (among many) took on the powers that be to say it was simply wrong that persons were dying because they had no access to ART.

I strongly support Paul’s vision – I think this would be an amazing transformation of how development and health – poverty and justice – are viewed.

I am strongly confident that Paul’s principles will make him a champion of women’s health and rights in the strongest way possible…and while there will be areas of divergence and disagreement, I think he has proven himself willing to take on the powers that be; to take on contentious issues; to listen and learn; and to do what is right.

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suggests caution. Jim Kim and John Mann tilted windmills with large organizations (who) with little success. Paul has a great deal to offer but sometimes advising the beast rather than living in its mouth is the best strategy.

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“What better chance to change things for the better than to have Paul at the helm? He is a pioneer in health and human rights.”

Dr Farmer harnesses the knowledge, skills, abilities, and experience to handle all that comes to him in Washington. He is the perfect candidate to help the Obama administration bring systemic change not only to American world assistance, but to their own nation as well.

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Paul Farmer to head USAID? Farmer is a competent, dedicated development expert but is hardly equipped to run a major bureaucracy in dire need of reform.